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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZELTON AVENUE - STOCKTON CA 96205-(209)468-3420 NON-KEFUNDABLE PERMIT L."ALL LV`J YDJ-/DJ/ FOR INSPECTIONS tXPIRES l TEAR FROM DATE ISSUEI JOB ADDRESS 3008 FLORIDA AVE STOCKTON CA CITYIZ�' C'5 ✓Z'J CROSS STREET MYRAN AVE APN 119-270-33 PARCEL SIZE`TM0'T 3 OWNER NAMEROBIN MENCIA pHONE415"680-4196 OWNER ADDRESS 676 SHENANDOAH PL HAYWARD CA CITYISTATEIZIP 94544 CONTRACTOR PHONE CONTRACTOR ADDRESS CITYISTATEIZIP LICENSE C42 C36 OTHER NUMBER EXPIRATION DATE WATER TABLE DEPTH: It GEOGRAPHICAL INFORMATION: Coordinates X Y Amount PermtU Invoice# Permit IDS Date PERC TEST # I BUILDING PERMIT # B Cash LAND USE APPLICATION # TYPE OF WORK: NEW INSTALLATION REPAIR/ADDITION ISS c ENGINEER DESIGNED /ALTERNATIVE]] ` REPLACEMENT OUT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION Septic tank 1115 INSTALLATION WILL SERVE: RESIDENCE COMMERCIAL OTHER NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: ❑ SEPTIC TANK TYPEIMFG CAPACITY gal # OF COMPARTMENTS ❑ GREASETRAP TYPE/MFG CAPACITY gal #OFCOMPARTMENTS DISTANCE TO NEAREST: WELL ft FOUNDATION It PROPERTY LINE ft ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR (ENCLOSED SYSTEM) ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE It ❑ FILTER BED WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE ft ❑ MOUNDED WIDTH ft LENGTH It DEPTH ft DISTANCE TO NEAREST WELL It FOUNDATION It PROPERTY LINE It ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft DISTANCE TO NEAREST WELL R FOUNDATION It PROPERTY LINE It ❑ DISPOSAL PONDS WIDTH It LENGTH It DEPTH It DISTANCE TO NEAREST WELL ft FOUNDATION It PROPERTY LINE It ❑ SEEPAGE PITS NUMBER WIorH It DEPTH ft DISTANCE TO NEAREST WELL ft FOUNDATION _ft PROPERTY LINE ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. w DEPAR TMENT USE ONLY � Application Accepted B r ' L� L� Date T d Area �CI Employee IDS Al Final Inspection SPECIAL PERMIT -Approved by Character of Soil toDepthDepI of�T PI Sump Soll Character: COMMENTS �' }cl' o '; (';*^I S jo) 1•'bbC < PE SC Received Check*/ Amount PermtU Invoice# Permit IDS Date Code INFO B Cash Remitted Service Request # 'j)d) 0's- S0. ISS c 42-01 � . �i 1 �1 S 3 / � G ONSITE WASTEWATER TRTMNT SYSTEM PERMIT 4/1M1e ✓�(/,�✓f ✓tel/Ei/. II /ENT :IVE® 3 2022 IN COUNTY MENTAL PARTMENT